When some in the LGBTQ community talk about “the bad old days” they largely mean that period of time when they lived in fear.

People would mock them in public, and do worse in the dark of night.

Many found themselves the victims of violence, sometimes sexual violence, by intolerant people who wanted to humiliate them.

Over the last decade, much of this has changed. A larger portion of the American public accepts gay relationships, according to Dr. Sally Mravcak, of Vanguard Medical Group, who recently took part in the Jersey City Pride Festival.

“While the community has made progress overall, this is not true of the transgender population,” she said. “A Gallup poll showed that more than 60 percent of Americans surveyed found gay relationships acceptable.”

But for many transgenders – especially those living in suburban and rural areas – these still are the bad old days.

This is more than just about the use of toilet facilities, an issue that has made headlines over the last few years.

Violence against transgender people appears to be as big a problem today as it was against other gays in the past.

“Transgenders are discriminated against. They face brunt physical attacks. They have emotional distress. They are harassed an assaulted,” Mravcak said.

A 2015 U.S. Transgender survey, she said, showed they are routinely verbally, physically and sexually assaulted, and often live with physical distress.”

According to the Human Rights Campaign, in 2016, advocates connected at least 22 deaths of transgender people in the United States to fatal violence. Many of those were victims of acquaintances and partners as well as strangers.

While some assailants have been charged, others have slipped away into the dark of night, much as anti-gay bullies did in the past.

Unlike members of the gay community who have made significant strides in obtaining rights due them in mainstream community, transgender people face not only violence, but sometimes open discrimination that deprives them of employment, housing, healthcare and other necessities, barriers that make them vulnerable.

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“Transgender are discriminated against. They face brunt physical attacks. They have emotional distress. They are harassed an assaulted.” – Dr. Sally Mravcak____________

Taking pride

To highlight this problem, founders of the Pride Festival made it a point this year to offer support to the transgender population.

This partly came in response to President Donald Trump’s call to ban transgender people from serving in the U.S. military. While the ban has yet to go into effect, many see this as contributing the persecution of a very vulnerable population in the United States.

Dr. Mravcak said such an atmosphere along with other issues has also contributed to a spike in potential suicides in the LGBTQ community.

“The number of suicides is high,” she said.

Transgender people are often excluded by religious organizations and family. While there tends to be strong support in places like Jersey City, those that live far from urban centers face serious social issues.

“Many are bullied in school, and an online survey showed that many have seriously considered suicide, a quarter of them have attempted it,” Mravcak said.

An analysis last year by the Williams Institute at UCLA School of Law found that 41 percent of transgender and gender non-conforming individuals had attempted suicide. Gender affirmation treatment has been shown to reduce suicide by around 75 percent.

Nationwide, two in ten transgender Americans are denied health care because of who they are. One in three faces significant delays getting necessary medical attention. Jersey City last year announced that it would provide health coverage for transgender city workers.

Clara, a Jersey City transgender, said lack of health insurance for transgender people is a huge problem, partly because many face other health issues and partly because many need guidance from a trained physician to get through the complicated regimen of hormones and other drugs.

Stress over health issues can be overwhelming, she said, and transgender people have significant medical and financial issues that the extended insurance coverage would help resolve. One in three faces significant delays getting necessary medical attention. This lack of access to care can have serious negative consequences, including depression and suicide.

Mayor Steven Fulop and the City Council expanded the health care coverage it offers city employees to include coverage for transgender medical care and related procedures, including gender affirmation surgery.

A place to go

Vanguard opened offices in Jersey City in May 2016, and along with providing medical services to the general population, it also provides LGBTQ-friendly services as well.

Transgenders and others in the LGBTQ community still face discrimination in getting medical care. Sometimes this is simply due to misinformation by doctors who do not understand the needs of this particular population.

“Some doctors believe lesbians do not need to have pap smears,” Mravcak said.

This kind of misinformation puts people at risk of getting serious diseases, and also increases the distrust people feel.

Vanguard, she said, tries to create a trusting atmosphere, and giving people subtle signals that the office can provide these services. This may include simple decorations that promote gay pride or a rainbow pin on the doctor’s or nurse’s gown.

While the office does not cover all aspects of transgender treatment such as hormone replacement or surgery, it does provide all the prep work, as well as provides information and referrals to reliable other medical services.

“We are well versed in the needs of the community,” she said. “We can assess risk. Many are not comfortable with other doctors and this becomes a barrier to care. They avoid going to doctors even for something as simple as a sore throat because they are afraid they will be mistreated.”

One third of transgenders have had a bad experience with doctors, she said, quoting a survey.

She said it is important not to be judgmental, and so if someone says they have multiple sexual partners, this becomes important information in helping them maintain good health.

“It’s important to know how to ask these questions,” she said.

The LGBTQ community has a number of medical issues and areas of risk, such as HIV and certain sexually transmitted diseases.

“Syphilis is rising in all populations, but significantly higher in men who have sex with other men,” she said.

The human papilloma virus (HPV) can cause cancer in gay men and women, she said, so this becomes something doctors need to be aware of. Hepatitis A and B are also issues.